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The mystery of colonic calcification!

Clinical scenario : 
     A 22-year-old female presented to our with a history of intermittent abdominal pain of 4 weeks duration. She described the pain as mild (score of 3/10), dull aching,in the whole abdomen with no reference or radiation. She denied abdominal distension, constipation or vomiting.
     Her vitals were stable. Her abdomen was not distended, soft and there was no tenderness or guarding. There was no organomegaly or free fluid and her bowel sounds were normal. Her other systemic examination was unremarkable.
      Her hemogram, erythrocyte sedimentation rate (ESR), renal function tests, serum amylase, lipase and liver function tests were normal. Abdominal CT scan (Figure 1) revealed diffuse
colonic calcification starting from rectum to splenic flexure, sparing transverse colon and involving the whole ascending colon.

Fig 1 CT scan abdomen showing diffuse colonic calcification.
CT scan of the abdomen did not demonstrate any vascular calcification or any other abnormality.
Colonoscopic examination up to terminal ileum showed no mucosal erythema, ulcers, discoloration or luminal lesion. Multiple random biopsies were taken from various parts of the colon and ileum. Histopathologial examination later revealed no features of ischemia, granuloma or any other abnormality. She had no ova or parasites on stool examination. Further evaluation revealed
normal upper GI endoscopy. She had negative celiac serology. Her serum electrolytes, serum calcium, phosphorous and parathyroid hormone levels were within normal limits. Her Montoux test (PPD) was negative and limited skeletal X-ray survey showed no abnormality. She
has remained asymptomatic for the last 8 months and repeat CT scan of the abdomen did not reveal any interval changes  What caused the calcification in her colon remained a mystery!
Further reading: Calciphylaxis


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